In a long-overdue move, provider reimbursement rates under the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) have been de-linked from Medicaid rates, effective January 1, 2008. The HIRSP Authority Board of Governors approved the new methodology at its meeting on December 17.

HIRSP is the state’s health insurance program for medically uninsurable individuals who do not have access to employer-sponsored health insurance. The program currently covers 17,000 people.

In the past, HIRSP reimbursement was generally expressed as a multiple of Medicaid rates. In 2007, for example, HIRSP paid 149.6 percent of what Medicaid would pay for the same service. The specific percentage was adjusted every year to "collect" the required provider share of HIRSP program costs.

Under Wisconsin law, policyholder premiums fund 60 percent of program costs, assessments on health insurers fund 20 percent and reductions in provider reimbursement from what HIRSP would otherwise pay fund the remaining 20 percent. Insurers and providers equally share in funding premium and deductible subsidy costs for low-income enrollees.

The discount imposed by HIRSP on hospitals, physicians and other providers must be greater than 20 percent because program costs include administrative costs, there are no provider contributions related to prescription drugs, and providers fund 50 percent of the subsidy costs. For 2008, the discount will be 29 percent.

The changes approved by the HIRSP Board mean that HIRSP has established a fee schedule for most services. As a result, required discounts can be calculated accurately for the first time on a per-claim basis. Providers will be paid at 71 percent of the HIRSP fee schedule or DRG rates, with the other 29 percent being identified as the provider contribution toward HIRSP costs. The changes are cost-neutral to the 2008 budget adopted by the HIRSP Board earlier this year.

The provider contribution will be separately identified on remittance advice issued by WPS, the HIRSP administrator, beginning shortly after the first of the year.

For hospitals, the 2008 DRG weights/rates produce a reimbursement of 2.227 times Medicare, minus the 29 percent discount. Outlier payments will be made using a variable trim point of 1.55 times the standard DRG payment, again with a 29 percent discount. Hospital outpatient services will be paid at 71.5 percent of billed charges, minus the 29 percent discount.

Within the past two weeks, the WHA Foundation has received two significant contributions to its annual fundraising campaign. On December 13, the WHA Financial Solutions Board of Directors approved a $25,000 contribution for 2007.

"WHA Financial Solutions is pleased to support the efforts of the WHA Foundation. It’s just one way we can give back to Wisconsin’s health care community and our health care clients," said WHA Financial Solutions’ Senior Vice President, Jon Braddock.

On December 20, the Board of Directors of Infinity Healthcare, Milwaukee, approved a contribution of $20,000 to the WHA Foundation. Infinity Healthcare developed EMSystem nine years ago. This Internet product was used to track emergency department (ED) diversionary status among Milwaukee area hospitals and the EMS system in Milwaukee County. EMSystem was sold recently to a private group and as a result of the sale, the Infinity Healthcare Board wanted to show its appreciation to WHA for its support from inception through development of emergency preparedness products. Infinity Healthcare staffs a number of EDs from Green Bay to Racine.

With these generous contributions from WHA Financial Solutions, Infinity Healthcare, and many other hospitals, health systems and individuals from throughout Wisconsin, the Foundation has raised nearly $65,000 to date. The monies raised each year by the Foundation are used to fund statewide initiatives that support hospitals throughout the state, including the annual scholarship program and other workforce development initiatives, quality and patient safety initiatives, and the annual Global Vision Community Partnership Award.

Aspirus, Wausau
Infinity Healthcare
WHA Financial Solutions, Madison
Wheaton Franciscan Healthcare, Milwaukee

Contributions from Organizations

Loren Anderson, Aurora Health Care – Southern Region
Jenny Boese, Wisconsin Hospital Association
Eric Borgerding, Wisconsin Hospital Association
Steve Brenton, Wisconsin Hospital Association
Ken Buser, Wheaton Franciscan Healthcare – All Saints, Racine
Jennifer Frank, Wisconsin Hospital Association
Mary Kay Grasmick, Wisconsin Hospital Association
Tommy Hobbs, Ripon Medical Center, Ripon
Dan Hymans, Memorial Medical Center, Ashland
Mike Karuschak, Amery Regional Medical Center, Amery
John Kosanovich, Watertown Memorial Hospital, Watertown
Roger Lucas, Aspirus, Wausau
Paul Merline, Wisconsin Hospital Association
Brian Potter, Wisconsin Hospital Association
George Quinn, Wisconsin Hospital Association
Terri Richards, Saint Joseph’s Hospital, Marshfield
Mike Sanders, The Monroe Clinic, Monroe
Mike Schafer, Spooner Health System, Spooner

No state health reform initiative has received more national exposure and fanfare than the Massachusetts Health Care Reform Plan. The bipartisan initiative was hailed as landmark legislation when it became law in 2006 and promised "affordable and accessible" coverage for "nearly all" Commonwealth citizens. The initiative combined the concept of individual responsibility via an individual mandate on insurance coverage with government subsidies to ensure affordability. The Plan also created a public/private sector "Commonwealth Connector," an agency that connects individuals and small businesses to a menu of affordable (and in some cases subsidized) insurance products.

The good news is that the subsidized insurance program has been hugely popular. In its initial year of operation, the program enrolled 160,000 low-income individuals and families—many more than anticipated. The bad news is that in addition to the expense associated with higher than anticipated enrollment, initial claims data indicates higher than predicted utilization of services. Massachusetts officials now estimate that program costs for the current fiscal year will be 25 percent over budget—that’s a $150 million overrun in the first year.

Massachusetts leaders are scrambling to "fix" the budget deficit. The Connector’s Board Chair says the goal "is to make this great health care reform effort sustainable." In order to achieve that sustainability, officials are taking aim at hospital and physician rate cuts. In fact, one prominent state official pronounced his opinion that "there’s no justification for paying (providers) more than Medicaid rates." In fact, provider rate cuts appear to be more popular than other available options that include a reduction in the comprehensive range of health services covered by the plan and/or increasing co-payments for plan participants whose incomes are above the poverty level.

One of the lessons to be learned from the early Massachusetts experience is the strong public appetite for "free" or heavily subsidized health care. We’ve seen that in Wisconsin with the SeniorCare and FamilyCare programs—both of which are proving to be politically popular and more expensive than anticipated. How will similar, big ticket "health reform" proposals being talked about in Wisconsin, such as Healthy Wisconsin, be different? The other lesson, of course, is the fact that adequate provider payment is generally the first casualty when the numbers don’t add up.

Steve Brenton, President

The Wisconsin Council on Medical Education and Workforce (WCMEW) meeting on December 10 included a demonstration of a new physician recruitment Web site, DocJobsWis. The new Web site, which is expected to be rolled out in March 2008, will provide hospitals and health systems with potential physician staff candidates, and physicians with job openings throughout Wisconsin. WCMEW will particularly target physicians who are practicing outside of Wisconsin who have Wisconsin ties. Only about a third of physicians trained in Wisconsin ultimately practice here. The objective is to attract those physicians back to our state.

WCMEW also plans to survey practicing physicians and medical directors in early 2008 to gain their perspectives on issues such as career plans and satisfaction, recruitment and retention, access to care, and basic demographic information. The survey will be conducted by the Wisconsin Medical Society.

If you have questions regarding WCMEW, contact George Quinn or Dr. Chuck Shabino at WHA.

Wisconsin nursing schools are seeing fewer students pass the state nurse licensure exam now than in the past. The Wisconsin Board of Nursing receives pass rate reports for all programs and reviews data for a rolling two-year period. The Board expects schools to maintain a pass rate at or above the national level, which is currently 87 percent. A lower pass rate places the school in "monitoring" status, which then requires the school to routinely report back to the Board. The Board can take further action, either placing the school on "probation" or limiting its ability to admit students.

According to the Wisconsin Nursing Association, for the period 2005-2007 the Board is monitoring 12 nursing schools because of significant RN fail rates for NCLEX test takers. They include:

• 2 private associate-degree schools
• 5 ADN technical college district associate degree schools
• 5 BSN private schools

For the same period, there are two (of 17) practical nursing programs being monitored, both in the technical college system. The score required to pass this exam will be raised in April, which is likely to lead to even fewer students earning a passing score.

Failure of either licensing exam means that graduates may no longer practice on their temporary permits. If hospitals decide to continue employment, graduates must be placed in other roles/jobs. Although there are no restrictions on the number of times an exam may be taken, the Board of Nursing strongly encourages graduates to re-take the exam as quickly as possible, and has taken the position that graduates may occupy a ‘nurse technician’ role for no longer than six months post graduation.

The increasing number of new nurses who are unable to pass the exam and obtain a license is becoming a problem for hospitals. While the Board of Nursing and schools work to improve the test outcomes, hospitals need to have plans in place to address this as a human resource issue.

The Wisconsin Department of Natural Resources on December 19, 2007 publicly released a memorandum that clarifies state DNR and federal EPA regulation of waste epinephrine in Wisconsin. Epinephrine in its salt form is widely used in health care.

As a result of the clarification, "some health care facilities may find that this regulatory change relieves them of paperwork, training and other hazardous waste requirements," according to a new section of the DNR Web site accompanying the memorandum.

"In practical terms, this decision [in the DNR memorandum] means that most epinephrine waste from health care is no longer regulated as P042 listed hazardous waste," states the DNR’s Web site. The EPA issued similar guidance in October 2007.

The DNR’s memorandum also reminds waste generators of other obligations under Wisconsin’s waste regulations.

A copy of the DNR memorandum can be found at http://dnr.wi.gov/org/aw/wm/publications/anewpub/WA1208.pdf. DNR’s website article on the new memorandum can be found under "Special Considerations" at http://dnr.wi.gov/org/aw/wm/pharm/nonhousehold.htm.

The Internal Revenue Service (IRS) has released the final version of Form 990, including Schedule H for hospitals, that now includes reporting requirements for Medicare shortfalls and bad debt expense. Schedule H now includes six sections:

• Part I, "Charity Care and Certain Other Community Benefits," includes questions regarding charity care policies and asks for people served and dollars expended.
• Part II, "Community Building Activities," is a continuation of questions about community benefits, but restricted to community building activities such as physical improvement and housing, and workforce development.
• Part III, "Bad Debt, Medicare and Collection Practices," asks whether the hospital’s bad debt reporting practices conform to the Healthcare Financial Management Association’s principles, the Medicare shortfall (and how much of it should be considered a community benefit), and includes questions about the hospital’s debt collection practices.
• Part IV asks about management companies and joint ventures, Part V covers facility information, and Part VI asks for supplemental information.

Parts I through IV are optional for the 2008 tax year, Parts V and VI are required for 2008. All Parts are required starting in the 2009 tax year.

Experts in the treatment of alcohol and drug abuse remain steadfast in their assessment that education, awareness and community involvement are all factors that can lead to a decline in the incidence of chemical dependency. The more people know, the more the disease can be controlled.

Armed with that acknowledgement, the L.E.Phillips-Libertas Treatment Center of St. Joseph’s Hospital, Chippewa Falls, continues to offer free community education programs on alcohol and drug-related topics. The monthly programs have been offered for nearly five years, are free of charge and are designed for both the general public and professionals. Professionals may apply for continuing education credits.

A myriad of treatment professionals from the region present the monthly programs and numerous treatment center staff have also been presenters.

Topics have been many; some include grief and addiction, rage and addiction, holiday stress, criminal activity and dependency, music therapy’s role in treatment and many others.

Held onsite at the L.E.Phillips-Libertas Treatment Center, attendance has steadily grown and fluctuates depending on subject matter. Attendees are a mix of professionals and the general public.

The free, monthly programs are a beneficial resource for education about the disease of alcohol and drug abuse. The benefits are shared with the general public and with professionals who serve others.

No one plans to fall, but many common conditions that affect seniors such as stroke, diabetes or arthritis can increase the risk of a fall. Knowing they’re at risk can add anxiety to everyday tasks and decrease quality of life. To help seniors gain the freedom and confidence needed to stay in their own homes, Mile Bluff Medical Center in Mauston offers free balance and safety screenings to all seniors in the community once a year.

The screenings are offered through the Rehabilitation Services Department, and include:

• Balance & walking assessments
• Medication reviews
• Kitchen safety assessments
• Blood pressure screenings
• Lower extremity sensory tests
• Cognitive assessments
• Hearing screenings

This comprehensive assessment is designed to assist seniors in minimizing their risk of falling and maximizing their independence and safety. The Mauston area is a popular place to retire, so in recognizing a need in the community, Mile Bluff stepped up to the plate to offer the benefit of these screenings, and in turn has helped many senior citizens learn to stay safe and independent in their own homes.

Screenings address early childhood development

There are an unlimited number of questions that come with parenting, and as parents, learning through personal experience—or the experience of others—many times is the only way to get answers. However, there are certain indicators that help determine whether a child is on the right path in developing their communication and motor skills that can be assessed by a professional.

Parents commonly have questions about what the average age is for a child to begin crawling, speaking words, walking, putting sentences together, running, reading, or skipping. To help parents get some of these answers, Mile Bluff Medical Center in Mauston offers free early childhood screenings twice a year. This service is open to all parents in the community with children birth to five years of age—whether a problem is suspected or not.

A speech/language pathologist, occupational therapist, physical therapist and audiologist from Mile Bluff’s staff each sets aside a full day to asses motor and communication skills of all individual participants. Children visit each of the stations to perform a number of fun activities, and parents have the opportunity to ask questions of each of the professionals. To follow up the screenings, "report cards" are sent out and doctor referrals are obtained if needed.